HISTORY: The patient is a 51-year old African American female who presented to the Washington University Dermatology Clinic with a 6-month history of progressive sores on her scalp with extensive hair loss and scarring. She reported that the sores were painful; however there was no bleeding or pruritus. Review of systems was negative for oral lesions and ophthalmic problems. There was no family history of lupus or alopecia.
PHYSICAL EXAMINATION: The patient had scarring alopecia involving the entire parietal scalp with diffuse polytrichia. Multiple vesicles and serocrusted erosions surrounded by areas of erythema and hyperpigmentation were noted at the hairlines (Figs 1-2). Multiple 1-2 mm white milia were present in the scarred portions. During the initial office visit the lips and oral mucosa were within normal limits.
LABORATORY FINDINGS: Liver function tests and G-6-PD screening were normal. CBC was notable for eosinophilia at 7.5%
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